- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.90 / $247.98 / $303.20
| Professional | | $187.90 | $247.98 | $303.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.66 / $300.05 / $429.42
| Professional | | $223.66 | $300.05 | $429.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.00 / $317.00 / $456.00
| Facility | | $317.00 | $317.00 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.75 / $325.89 / $567.01
| Professional | | $216.75 | $325.89 | $567.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.95 / $314.10 / $557.50
| Professional | | $234.95 | $314.10 | $557.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.90 / $247.98 / $453.05
| Professional | | $187.90 | $247.98 | $453.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.61 / $352.76 / $543.26
| Professional | | $240.61 | $352.76 | $543.26 |